Angina is one of the most common manifestations of coronary artery disease (CAD), in which the blood vessels nourishing the heart itself cannot deliver enough blood to the cardiac muscle. Any extra demands on the heart-exercise, stress, exposure to cold, digesting a heavy meal – can lead to ischemia, a condition in which areas of muscle are starved for oxygen. Chest pain, tightness, or other discomfort is the most common symptom, but some people experience shortness of breath instead of (or in addition to) the classic pain.
Stable angina is usually very predictable; for example, symptoms invariably develop when a person reaches a specific level of exertion, such as climbing two flights of stairs or walking three blocks at a brisk pace. Symptoms usually subside after resting a few minutes or after taking nitroglycerin, a drug that increases blood flow in the coronary arteries and reduces the heart’s workload.
Some people develop atypical angina, in which symptoms develop during rest but are not usually provoked by exercise. It is usually due to spasms of the smooth muscles that control the size of the coronary arteries. Spasms generally occur at the site of fatty deposits.
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Symptoms
- Pain, tightness, or other discomfort starting in the center of the chest and radiating (or occurring only) in the arm, neck, shoulder, jaw, or back, especially on the left side.
- Pain or other symptoms exacerbated by exercise, stress, exposure to cold and wind, or eating a heavy meal.
Who is at Risk?
Atherosclerosis, the buildup of fatty deposits (plaque) in the artery walls, is the major risk factor for angina pectoris, the medical term for chest pain. The exact cause of atherosclerosis is unknown, but contributing factors include high blood cholesterol, diabetes, and tobacco use. Recent studies also implicate high levels of homocysteine, a protein (amino acid) that can damage the artery walls; chlamydial respiratory infections; and chronic gingivitis, a gum disease.
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Herbal Medicine
An extract of vitex fruit – also known as chaste tree or monk’s pepper – is an ancient herbal remedy for cystic breasts and other premenstrual symptoms. It is available as concentrated liquid, powder, or tablets; it should be taken daily for at least four months. Raspberry leaf tea is another tonic that some women find eases breast symptoms. Some studies have found that evening primrose oil, in doses of 1000 mg three times a day, relieves breast pain. Do not use evening primrose oil if you are taking anticoagulants.
Nutraceuticals
There are numerous anecdotal reports that Vitamin E, in doses of 400 to 800 IU a day, reduces symptoms related to fibrocystic breasts. Check with your doctor before taking Vitamin E if you are also taking aspirin or other blood-thinning medication.
Warning!
Hormone manipulation should be considered a treatment of last resort for fibrocystic breast pain. The drugs used can cause menopausal symptoms and other side effects that may be worse than the breast discomfort.
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Cutting down on salt, especially in your premenstrual phase, may help limit breast swelling and cyst formation. Some studies have found that reducing or, better still, eliminating caffeine and methylxanthines-substances found in coffee, chocolate, tea, and colas – eases breast tenderness. Studies indicate that women who suffer from severe breast tenderness tend to be overly sensitive to caffeine and methylxanthines, and that eliminating them from the diet will provide relief for many. Adopting a low-fat diet and losing excess weight may also help by preventing the body from producing too much estrogen – a likely factor in fibrocystic breast tenderness.
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A mild diuretic (water pill) may be prescribed to reduce premenstrual swelling and fluid retention. In very severe cases, drugs that block estrogen – danazol (Cyclomen), tamoxifen (Nolvadex), or bromocriptine (Parlodel)- may be prescribed. However, the problem may return when the drugs are stopped.
Most breast cysts clear up on their own and disappear completely after menopause. A doctor may elect to drain very large or painful cysts. Some fibroadenomas grow large enough to distort the breast contour and require surgical removal. In addition, many doctors recommend routine removal of fibroadenomas, especially when they occur in middle-aged or older women. Although the growths themselves are benign, they can be difficult to distinguish from cancerous tumors. Removal allows a doctor to examine the tissue for any abnormal cells.
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Acetaminophen or Ibuprofen can usually relieve mild discomfort. Try wearing a well-fitted bra that is one size larger than usual when the breasts are swollen during the premenstrual phase. Regular exercise may also help; one study found that women who run an average of 10 miles a week had an improvement in their breast symptoms.
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Fluctuating levels of estrogen and progesterone – the major female sex hormones – stimulate the breast changes during a woman’s menstrual cycle. During the premenstrual phase, breasts tend to become tender or even painful as they swell with extra fluid and blood; cysts of varying sizes may also develop. If conception does not occur, hormone levels fall, the breast swelling recedes, the tenderness goes away, and many of the cysts disappear. Cyst formation tends to increase as women enter their 40s and approach menopause; after menopause, however, they are quite rare.
Sometimes, one or more cysts remain and, in time, may fill with the solid, fibrous material characteristic of fibrocystic breasts. At one time, this was referred to as a disease and was considered a risk factor for breast cancer. Doctors now recognize that fibrocystic breasts are an exaggeration of normal changes and are unrelated to cancer.
Solid benign growths called fibroadenomas may also develop, especially in young adults. These are also harmless, but because they are difficult to tell from cancerous tumors, any new breast lump that persists through two or three menstrual cycles should be checked by a doctor.
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The cause of primary esophageal spasm is unknown. Chest pain, which is often mistaken for a heart attack, develops when the muscles that normally contract in orderly waves, called peristalsis, suddenly go into a spasm. These spasms generally occur while eating or drinking, prompting the sphincter muscles, which allow food and fluids to pass into the stomach, to clamp shut. This results in difficulty swallowing and a sensation that something is stuck in the throat.
Over time, the spasms may evolve into achalasia, a disorder marked by faulty communication between the esophageal muscles and the nerves that control them. The esophagus bulges outward and then narrows just above the lower esophageal sphincter. In very severe cases, the esophagus may rupture due to excessive pressure caused by the distended esophagus and constricted sphincter.
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SYMPTOMS
~ Pain centered in the upper chest, perhaps radiating to the neck, jaw, and arms.
~ Pain and difficulty when swallowing.
~ Uncomfortable sensation of food stuck in the throat.
~ Chronic cough, especially at night.
Who is at Risk
Recurring esophageal spasms can develop at any age, but they typically begin between ages 20 and 40; men and women are affected equally. People who suffer from chronic heartburn or indigestion have an increased risk of spasms, which are often aggravated by stress and very hot or cold liquids.
BREAKTHROUGHS!
A new treatment of refractory spasms or achalasia uses injections of botolinum toxin (Botox), the nerve toxin that causes botulism. Tiny amounts of the Botox are injected into the muscle controlling the lower esophageal sphincter, causing it to relax. This works in 70 to 80 percent of patients. However, the effects wear off in 6 to 12 months, at which time the injection can be repeated.
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